Loading...
In patients with acute decompensated heart failure, elevated levels of the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) have been associated with poor prognosis (Circulation 2002; 105:2392). To assess this marker's value in stable coronary heart disease (CHD), researchers prospectively studied 987 stable CHD patients (81% men; 18% with a history of heart failure) in the Heart and Soul Study. The cohort's median baseline NT-proBNP level was 175 pg/mL.
During a mean follow-up of 3.7 years, 256 patients (26%) experienced a cardiovascular (CV) event or died. The higher the baseline NT-proBNP level, the greater was the annual risk for CV events or death, ranging from 2.6% in the lowest NT-proBNP quartile (8–74 pg/mL) to 19.6% in the highest quartile (≥460 pg/mL). NT-proBNP testing also added statistically significant prognostic value to traditional baseline risk assessment, which included echocardiographic measures.
Bibbins-Domingo K et al. N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP), cardiovascular events, and mortality in patients with stable coronary heart disease. JAMA 2007 Jan 10; 297:169-76.
Konstam MA. Natriuretic peptides and cardiovascular events: More than a stretch. JAMA 2007 Jan 10; 297:212-4.
Comment
This study documents the potential value of NT-proBNP as a risk marker in patients with stable CHD. The findings are intriguing, but further research is required to determine whether NT-proBNP testing would help to improve outcomes in these patients. For now, the evidence is insufficient to justify measuring NT-proBNP as part of routine screening of stable CHD patients, whose need for aggressive therapy is already clear. Clinicians should continue to manage these high-risk patients according to current secondary-prevention guidelines (Journal Watch Cardiology Jun 8 2006). NT-proBNP might hold greater promise for determining therapy in intermediate-risk patients without CHD, but the marker’s predictive value in such patients has not been established.